Provider Demographics
NPI:1932227311
Name:SALENTINE, LORIE ANN (REG DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:ANN
Last Name:SALENTINE
Suffix:
Gender:F
Credentials:REG DENTAL HYGIENIST
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:ANN
Other - Last Name:SCHULKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REG DENTAL HYGIENIST
Mailing Address - Street 1:1248 MARIAN LANE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54162
Mailing Address - Country:US
Mailing Address - Phone:920-429-9664
Mailing Address - Fax:
Practice Address - Street 1:1711 SHAWANO AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303
Practice Address - Country:US
Practice Address - Phone:920-494-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5363016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist